| NPI | 1629538996 |
|---|---|
| Former Name | MADELINE CELESTE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: LA 343347) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2024-09-27 |